Organization
PRESTIGE RESIDENTIAL HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER B ASIEDU (ADMINISTRATOR)
(914) 417-0214
Entity
Organization
Contact information
Practice address
22367 E DESERT SPOON DR, QUEEN CREEK, AZ 85142-1235
(480) 307-9984
Mailing address
22367 E DESERT SPOON DR, QUEEN CREEK, AZ 85142-1235
(480) 307-9984
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/29/2022
Last updated
03/29/2022
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